Dose–volume analysis of radiotherapy for T1N0 invasive breast cancer treated by local excision and partial breast irradiation by low-dose-rate interstitial implant

Lawenda, Brian D.; Taghian, Alphonse G.; Kachnic, Lisa A.; Hamdi, Hanaa; Smith, Barbara L.; Gadd, Michele A.; Mauceri, Thomas; Powell, Simon N.

doi:10.1016/s0360-3016(03)00071-3

Cited by 105 publications

(51 citation statements)

References 57 publications

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“…Interestingly, in their patient group they found an increasing proportion of patients rated as excellent during follow-up: 10% during the first 6 months after treatment and 33% after a minimum follow-up of 5 years. Comparable excellent to good results between 88% and 100% have been reported by several working groups [10,11,24].…”

Section: Discussionmentioning

confidence: 72%

Accelerated Partial-Breast Irradiation with Interstitial Implants

Ott

Lotter²,

Sauer³

et al. 2007

Strahlenther Onkol

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Section: Discussionmentioning

confidence: 72%

Accelerated Partial-Breast Irradiation with Interstitial Implants

Ott

Lotter²,

Sauer³

et al. 2007

Strahlenther Onkol

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“…Lawenda and colleagues found no association between implant volume and overall cosmetic outcome for 48 patients treated with LDR brachytherapy at their centre from 1997-2001 54 .…”

Section: Single Source Brachytherapy and Multi-source Brachytherapy (mentioning

confidence: 99%

A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

Harris

Mukesh

Jena

et al. 2014

Efficacy and Mechanism Evaluation

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Background Whole-breast radiotherapy (WBRT) is the standard treatment for breast cancer following breast-conserving surgery. Evidence shows that tumour recurrences occur near the original cancer: the tumour bed. New treatment developments include increasing dose to the tumour bed during WBRT (synchronous integrated boost) and irradiating only the region around the tumour bed, for patients at high and low risk of tumour recurrence, respectively. Currently, standard imaging uses bony anatomy to ensure accurate delivery of WBRT. It is debatable whether or not more targeted treatments such as synchronous integrated boost and partial-breast radiotherapy require image-guided radiotherapy (IGRT) focusing on implanted tumour bed clips (clip-based IGRT). Objectives Primary – to compare accuracy of patient set-up using standard imaging compared with clip-based IGRT. Secondary – comparison of imaging techniques using (1) tumour bed radiotherapy safety margins, (2) volume of breast tissue irradiated around tumour bed, (3) estimated breast toxicity following development of a normal tissue control probability model and (4) time taken. Design Multicentre observational study embedded within a national randomised trial: IMPORT-HIGH (Intensity Modulated and Partial Organ Radiotherapy – HIGHer-risk patient group) testing synchronous integrated boost and using clip-based IGRT. Setting Five radiotherapy departments, participating in IMPORT-HIGH. Participants Two-hundred and eighteen patients receiving breast radiotherapy within IMPORT-HIGH. Interventions There was no direct intervention in patients’ treatment. Experimental and control intervention were clip-based IGRT and standard imaging, respectively. IMPORT-HIGH patients received clip-based IGRT as routine; standard imaging data were obtained from clip-based IGRT images. Main outcome measures Difference in (1) set-up errors, (2) safety margins, (3) volume of breast tissue irradiated, (4) breast toxicity and (5) time, between clip-based IGRT and standard imaging. Results The primary outcome of overall mean difference in clip-based IGRT and standard imaging using daily set-up errors was 2–2.6 mm (p < 0.001). Heterogeneity testing between centres found a statistically significant difference in set-up errors at one centre. For four centres (179 patients), clip-based IGRT gave a mean decrease in the systematic set-up error of between 1 mm and 2 mm compared with standard imaging. Secondary outcomes were as follows: clip-based IGRT and standard imaging safety margins were less than 5 mm and 8 mm, respectively. Using clip-based IGRT, the median volume of tissue receiving 95% of prescribed boost dose decreased by 29 cm3 (range 11–193 cm3) compared with standard imaging. Difference in median time required to perform clip-based IGRT compared with standard imaging was X-ray imaging technique dependent (range 8–76 seconds). It was not possible to estimate differences in breast toxicity, the normal tissue control probability model indicated that for breast fibrosis maximum radiotherapy dose is ...

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“…PBI is administered using interstitial brachytherapy at low, pulsed or high dose rate (HDR), endocavitary HDR brachytherapy with MammoSite (Proxima Therapeutics, Alpharetta, GA), three dimensional external beam RT in the supine or prone position, intensity modulated RT and intraoperative RT (IORT) with electrons or photons (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Interstitial brachytherapy, the most common modality with the largest series of patients, delivers high doses to small volumes in the tumour bed and spares surrounding tissues.…”

Section: Introductionmentioning

confidence: 99%

Interstitial high-dose-rate brachytherapy after breast conserving surgery

Rulli¹,

Barberini²,

Scialpi³

et al. 2010

Oncol Rep

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Abstract. We evaluated local recurrence, toxicity rate and cosmetic outcome in 72 patients treated with high-doserate (HDR) brachytherapy after breast conserving surgery. HDR brachytherapy was administered: i) as partial breast irradiation (PBI) in 64 patients with low-risk early stage breast cancer, enrolled in a phase II prospective study; ii) as PBI after a second conservative surgery as treatment of local relapse in 3 patients; iii) for delivering a boost after whole breast external beam radiotherapy in 5 patients. Implantation was done during surgery (breast conserving or re-excision to achieve adequate surgical margins), with the wound open, or postoperatively. The implant was well tolerated in all patients, so no premature catheter removal was required. At a median follow-up of 32 months (range 5-52) no local recurrence has been observed. Toxicity was very low. Cosmetic outcome was excellent/good in a high percentage of patients. Our results suggest that PBI administered with HDR brachytherapy is feasible in selected patients with low risk early stage breast carcinoma. PBI seems feasible to repeat radiotherapy after a salvage breast conserving surgery for local relapse in a second attempt to preserve the breast.

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Dose–volume analysis of radiotherapy for T1N0 invasive breast cancer treated by local excision and partial breast irradiation by low-dose-rate interstitial implant

Cited by 105 publications

References 57 publications

Accelerated Partial-Breast Irradiation with Interstitial Implants

Accelerated Partial-Breast Irradiation with Interstitial Implants

A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

Interstitial high-dose-rate brachytherapy after breast conserving surgery

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